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Diagnostic Accuracy of Fat Pad Sampling and Bone Marrow Biopsy for AL Amyloidosis: A Systematic Review and Meta-Analysis
Journal article   Open access   Peer reviewed

Diagnostic Accuracy of Fat Pad Sampling and Bone Marrow Biopsy for AL Amyloidosis: A Systematic Review and Meta-Analysis

Muayad Azzam, Hassan Kawtharany, Jamil Nazzal, Qais Hamarsha, Aseel Alkhader, Tala Khraise, Mohammad M AlMasri, Hadi K Abou Zeid, Iktimal Alwan, Nour Jaber, …
Blood advances
09/04/2026
DOI: 10.1182/bloodadvances.2026021240
PMID: 42696041
url
https://doi.org/10.1182/bloodadvances.2026021240View
Published (Version of record) Open Access

Abstract

In this systematic review, we aimed to assess the diagnostic test accuracy (DTA) of abdominal fat pad sampling and bone marrow biopsy for immunoglobulin light-chain (AL) amyloidosis using organ biopsy as the reference standard. We searched the literature using PubMed, Embase, and CENTRAL databases from inception through March 2024. We used QUADAS-2 to assess the risk of bias and the GRADE approach to assess the certainty of evidence (COE). After deduplication, 29,237 records were screened, and 31 studies were included. Twenty-five studies (n=4,649) reported on fat pad sampling, with a pooled sensitivity of 0.77 (95%CI 0.72-0.81), while twenty studies (n=2,771) reported on bone marrow biopsy, with a pooled sensitivity of 0.55 (0.46-0.63). All studies enrolled patients with confirmed disease, specificity was not reported in the included studies. Fat pad aspiration (15 studies, n=1,590) and surgical or punch biopsy (4 studies, n=222) showed similar sensitivities of 0.80 (0.76-0.83) and 0.77 (0.61-0.88), respectively. In a single study (n=612), performing both tests together yielded a sensitivity of 0.89. COE was judged to be Moderate for fat pad sampling and Low for bone marrow biopsy.

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